Medicine by Design: The Architect and the Modern Hospital, 1893–1943 (review)

Abstract

Reviewed by: Medicine by Design: The Architect and the Modern Hospital, 1893–1943 Barbara Craig Medicine by Design: The Architect and the Modern Hospital, 1893–1943. Annmarie Adams. Minneapolis: University of Minnesota Press, 2008. Pp. 240, $82.50 cloth, $27.50 paper This slim volume usefully adds an architectural dimension to the literature on hospital history in Canada, addressing the development of the Royal Victoria Hospital in Montreal as a place for special medical practices, as a residence, and as a public necessity. Approaching the hospital as a site of material culture echoes the cultural approach adopted in recent histories of the book, computersitalic, and museums. The focus on things and processes as complexes of material culture opens up consideration of reciprocal influences. It draws upon the strengths of different disciplines and diverse methods and encourages an inclusive embrace of evidence. Such an approach highlights the role of negotiation over that of determination by a predominant power. Many distinct groups shaped the built fabric which at no time passively reflected the influence of one idea or technology. Throughout the five thematic chapters we are presented with a mosaic of interactions that shaped the buildings and their plan. The author, Annmarie Adams, is the William C. MacDonald Professor at the McGill School of Architecture and has previously published on hospital architecture at the end of the nineteenth century in Architecture in the Family Way: Doctors, Houses, and Women 1870–1900. The text is well written and amply illustrated by images and drawings. The University of Minnesota Press is to be commended for its series on Architecture, Landscape and American Culture in which this book is the third to appear. The introduction sets up the five chapters that follow, discussing the general argument of the volume within the context of the historiography of the hospital in Canada. This literature is dominated by individual institutional histories, some reflecting a medical perspective [End Page 779] while others memorialize the public life and service of the institution in celebration of a milestone or special achievement. Adamson takes quite a different tack, using the approach of material culture to interrogate the hospital, its design, materials, and various units as these were altered or added over time. Architectural drawings and the specialist professional literature serving architects and designers, as well as ample photographic evidence, are fully used to develop the argument. The result is a view of the hospital as a building and place tied to its site and materials as much as to its social and professional medical contexts. The author’s broader aim is to chart the development of the modern hospital, using the specific buildings of the Royal Victoria Hospital in Montreal as the focus. Architecture, including design, materials, and construction choices, is not viewed as a passive reflection of medical notions or practices or administrative priorities or public requirements. The case study approach focusing on the multiple players who influence design allows the author to uncover the complex of experts and users who together shaped the modern hospital. The author calls this negotiation a ‘dynamic alliance’ (xxv). It could also be characterized as a productive tension among players, priorities, and exigencies. The built fabric emerged from a complex interaction called ‘design,’ a process involving many players in intricate negotiations conducted under the pressure of immediate needs and against a backdrop of cultural conventions. Three chapters – ‘1893,’ ‘Architects and Doctors,’ and ‘Modernisms’ – are most directly relevant to the history of hospital architecture and will be of particular interest to historians of medicine because of this perspective. The architectural form of the hospital is the theme of chapter 1. Architectural intentions and sources of inspiration in precedent buildings, especially those in Europe, are discussed as a set-up for the construction of the Royal Victoria hospital. The architecture of the 1893 building was hotly contested among the players: the result was a building and plan that reflected the interplay of ideals that were often in conflict. Chapters 2 and 3 discuss how users experienced the hospital. Following the First World War, new groups were attracted to use hospital services as paying patients and outpatients. In addition, special accommodation and services catered to women and children...